Management of Depression and Related Neuropsychiatric Symptoms Associated with HIV/AIDS and Antiretroviral Therapy

Persons with HIV/AIDS may experience a wide range of neuropsychiatric symptoms, including depressed mood, anxiety,irritability, suicidal ideation, agitation and insomnia. These symptoms may be related to psychosocial stressors,biological diathesis to psychiatric syndromes, HIV-related medical illness and/or the medications used in the treatmentof HIV/AIDS. Depressed mood is the most common neuropsychiatric complaint in persons with HIV/AIDS seekingpsychiatric evaluation. Prevalence rates of major depression in persons with HIV/AIDS have been reported torange between 22% and 45%. Despite the high prevalence, major depression remains underdiagnosed in patients withHIV/AIDS. Depression has a significant impact on quality of life, has a negative impact on antiretroviral adherenceand is a significant risk factor for suicide.With the advent of highly active antiretroviral therapy, HIV/AIDS has evolved into a chronic, manageable illness.The management of mental health concerns and neuropsychiatric symptoms has, therefore, become an integral partof comprehensive HIV/AIDS care. Clinical experience to date suggests that psychiatric syndromes in persons withHIV/AIDS and treatment-emergent neuropsychiatric side effects related to antiretroviral medications can be successfullymanaged using standard psychiatric interventions. The present article focuses on the treatment and managementof major depression, including the choice of antidepressants and potential drug interaction considerations.Management of related symptoms of agitation and sleep disturbances are also reviewed